1 Truven Health Analytics, Bethesda, MD. 2 Merck & Company, West Point, PA. 3 Address correspondence to: Liisa Palmer, Ph.D., 7700 Old Georgetown Rd, Ste 650, Bethesda, MD 20814.
Transplantation. 2014 Jun 15;97(11):1178-84. doi: 10.1097/01.tp.0000441826.70687.f6.
To evaluate health-care utilization and costs attributable to herpes zoster (HZ) within a population of patients with solid organ transplant (SOT).
Using administrative claims data, a commercially/Medicare-insured population of patients with SOT between January 1, 1999, and January 1, 2007, and a Medicaid population between January 1, 1999, and January 1, 2006, were identified. Each patient group was screened to select patients with claims of SOT with an incident diagnosis of HZ and continuous enrollment for the 6 months prior and 3 months subsequent to the incident HZ. Controls were selected from group of SOT patients without claims of HZ using a propensity score matching process. Descriptive analyses were performed to quantify health-care utilization and costs attributable to HZ. Multivariate analyses were used to estimate HZ-attributable costs adjusted by demographic and clinical variables.
A total of 205 commercially/Medicare-insured matched pairs and 136 Medicaid matched pairs were selected. Mean age in the commercial/Medicare SOT-HZ population was 56.9 years, and that in the Medicaid population was 42.5 years. The majority of HZ patients were diagnosed within 2 years of evidence of SOT. The unadjusted differences in total HZ-attributable health-care costs were $4762 and $6705 for commercial/Medicare-insured and Medicaid patients, respectively (P=0.176 and P=0.003, respectively) and were largely driven by hospitalization costs. Adjusted incremental costs in the SOT-HZ commercial/Medicare-insured patients were $5335 (P<0.001), and that in noncapitated Medicaid patients were $3711 (P<0.001).
The occurrence of HZ in patients immunocompromised by SOT significantly increased health-care utilization and costs.
评估在实体器官移植（SOT）患者人群中，带状疱疹（HZ）导致的医疗保健利用和费用。
使用行政索赔数据，确定了 1999 年 1 月 1 日至 2007 年 1 月 1 日期间商业/医疗保险覆盖的 SOT 患者人群和 1999 年 1 月 1 日至 2006 年 1 月 1 日期间医疗补助人群。筛选每个患者组，以选择有 SOT 索赔且有 HZ 发病诊断的患者，并且在 HZ 发病前 6 个月和发病后 3 个月连续入组。使用倾向评分匹配过程从无 HZ 索赔的 SOT 患者组中选择对照组。进行描述性分析以量化归因于 HZ 的医疗保健利用和费用。使用多变量分析估计在人口统计学和临床变量调整后归因于 HZ 的成本。
共选择了 205 对商业/医疗保险匹配对和 136 对医疗补助匹配对。商业/医疗保险 SOT-HZ 人群的平均年龄为 56.9 岁，医疗补助人群的平均年龄为 42.5 岁。大多数 HZ 患者在 SOT 证据后 2 年内被诊断出。商业/医疗保险 SOT-HZ 患者的未经调整的总 HZ 归因医疗保健费用差异分别为 4762 美元和 6705 美元（P=0.176 和 P=0.003），主要由住院费用驱动。调整后的 SOT-HZ 商业/医疗保险患者的增量成本为 5335 美元（P<0.001），非统付医疗补助患者的增量成本为 3711 美元（P<0.001）。
SOT 导致免疫功能低下的患者发生 HZ 会显著增加医疗保健利用和费用。
